Non-invasive radial pulse wave assessment for the evaluation of left ventricular systolic performance in heart failure

Abstract

Introduction: Left ventricular (LV) developed pressure (dP/dt) is a classical index of myocardial contractility related to prognosis during heart failure. We sought to assess the reproducibility and feasibility of use of the maximal first derivative of the radial pulse, Rad dP/dt, as a peripheral criterion of ventricular contractility in patients with heart failure.

Methods: We assessed 50 consecutive, patients with heart failure using aplanation tonometry to record the radial pulse wave and calculate Rad dP/dt. Echocardiography, Doppler flow and tissue Doppler imaging were used to record classical parameters of LV function: LV ejection fraction (LVEF), Tei index, dP/dt on mitral regurgitation (MR dP/dt) and peak systolic velocity (S'). Total systemic vascular resistance (TSVR) was calculated by use of the Doppler calculated cardiac output. Preload was assessed by the E/Ea ratio. Feasibility was tested in an ongoing prospective mortality study (n=310).

Results: The Bland and Altman representation of repeated measurements of the Rad dP/dt showed good agreement. Feasibility was greater than 99% for a successful assessment on the right arm during the first attempt. The Rad dP/dt correlated with the LVEF, S' or Tei index as usual parameters of impaired contractility but not preload (E/Ea) or afterload (TSVR) parameters. MR dP/dt and Rad dP/dt were closely related (r=0.75, p<0.001). The ability of the arterial dP/dt to characterize LVEF was not modified by adjustment for arterial viscoelastic properties.

Conclusion: The maximal dP/dt of the radial pulse appears to be a valuable and reproducible peripheral criterion of LV systolic performance.